The study exposes the problem of incomplete disclosure and highlights the important relationship between sponsorship of guidelines and presence of conflict of interest.

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The prevalence of conflict of interest (COI) between clinicians and industry has been a topic of concern for the medical profession for more than two decades.

One area in which the presence of COI may be particularly concerning is the development of clinical practice guidelines, as their freedom from bias is important.

Although most organisations that produce guidelines have adopted COI disclosure policies, complete transparency is often not achieved, and may not be enough to prevent panel members' bias from influencing recommendations.

Using the Institute of Medicine's recommendations as a framework, a team of US researchers set out to determine the prevalence of financial COI among guideline panellists from organisations considered likely to reflect best clinical practice and influence behaviour.

They evaluated 14 guidelines published by national organisations in the United States and Canada between 2000 and 2010 that covered screening for and treatment of diabetes and high cholesterol (hyperlipidaemia).

They found that COIs were present for the vast majority of guideline panels reviewed.

Overall, 150 (52%) of panel members had COI, of which 138 were declared and 12 were undeclared. Among panels that had chairs, half of these had COI. Panel members from government sponsored guidelines were less likely to have COI compared with guidelines sponsored by non-government sources.

"Our data illustrate the pervasiveness of COI among members of guideline panels and may raise questions about the independence and objectivity of the guideline development process in the United States and Canada," say the authors.

They point out that the limited COI found among government sponsored guideline panel members "suggests that expert panels without many COI can be convened."

Conflict-free guideline panels are feasible and would help to improve the quality of the guideline development process, they conclude.

In an accompanying editorial, Professor Edwin Gale argues that academic and non-academic medicine "are pervaded by conflicts of interest, and too many people benefit from the situation for this to be openly acknowledged."

He believes a change in the culture of medicine is needed. "Until then, the drug industry will continue to model its behaviour on that of its consumers, and we will continue to get the drug industry we deserve," he concludes.

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